Ichigi Y, Takaki N, Nakamura K, Sato S, Kato A, Matsuo Y, Kudo S, Masaki Z
Department of Surgery, Saga Medical School, Japan.
Int J Urol. 1999 Oct;6(10):502-8. doi: 10.1046/j.1442-2042.1999.00103.x.
The hematoma size relative to the body size was measured on computed tomography films using a personal computer system in order to define whether that parameter is useful for decision-making in the management of blunt renal trauma.
From 1982 to 1997, 33 patients with intermediate or severe grade blunt renal trauma were retrospectively divided into three groups: group 1, managed conservatively without transcatheter embolization; group 2, managed by bedrest after selective transcatheter embolization; and group 3, managed operatively. In these three groups, the hematoma area (H) and the ratio of hematoma area to body area on CT (H/B) were measured and the chronological changes of the H/B in groups 1 and 2 were studied.
The H and H/B of group 3 were significantly larger than those of group 1. The H/B was more clearly distinguished for each group compared with the H alone. Well-preserved kidney integrity, despite the presence of a large hematoma in group 2, allowed the conservative treatment following transcatheter embolization of the bleeding site. The H/B of all group 1 patients gradually decreased and on the 40th or 50th day after injury they reached a level equivalent to the ratio of contra-lateral normal kidney area to body area.
The ratio of hematoma area to body area on CT was very useful in evaluating the grade of blunt renal trauma. In conservative treatment for blunt renal trauma changes of the hematoma size is a useful indicator for management.
为了确定血肿大小与身体大小的比值这一参数在钝性肾损伤治疗决策中是否有用，我们使用个人计算机系统在计算机断层扫描（CT）胶片上测量了该比值。
回顾性分析1982年至1997年期间33例中度或重度钝性肾损伤患者，将其分为三组：第1组，采用保守治疗，未行经导管栓塞术；第2组，在选择性经导管栓塞术后卧床休息；第3组，接受手术治疗。测量这三组患者的血肿面积（H）以及CT上血肿面积与身体面积的比值（H/B），并研究第1组和第2组患者H/B随时间的变化。
第3组的H和H/B显著大于第1组。与单独的H相比，H/B能更清晰地区分每组患者。尽管第2组存在较大血肿，但肾脏完整性良好，在对出血部位行经导管栓塞术后可行保守治疗。第1组所有患者的H/B逐渐下降，在受伤后第40天或第50天达到对侧正常肾脏面积与身体面积比值相当的水平。
CT上血肿面积与身体面积的比值在评估钝性肾损伤分级方面非常有用。在钝性肾损伤的保守治疗中，血肿大小的变化是治疗管理的有用指标。
